Chapter 1: Foundations of community and Public Health Nursing Practice

1. Community as client
2. Health as goal
3. Nursing as a vehicle or means to achieve

KEY CONCEPTS OF COMMUNITY AND PUBLIC HEALTH NURSING

To better understand the complex nature of community and public health nursing, we need to revisit three basic concepts:

COMMUNITY HEALTH NURSING

Specialized field of nursing practice that RENDERS CARE TO INDIVIDUALS, FAMILIES, AND COMMUNITIES; focusing on health promotion and disease prevention through people empowerment.

Health promotion and disease prevention

What are the cores of community health nursing? (2)

COMMUNITY HEALTH NURSING

What is the SYNTHESIS OF NURSING AND PUBLIC HEALTH PRACTICE applied to promote and protect the health of population.

Janet Heinrich and Ruth Freeman (1981)

WHO defined Community Health Nursing as "an AREA OF HUMAN SERVICES directed toward developing and enhancing the health capabilities of people - either singly, as individuals, or collectively, as groups and communities."

universal bioethical principles

Respect for people's inherent value regardless of their background and beliefs are edified in the ____________.

False

True or False

A fundamental commitment of community and public health nurses is NOT to adhere to the tenets of social justice. This principle speaks of promoting common good and not merely to be fair at all.

Justice

__________ is invoked when two or more competing claims are present.

Examples are allocating resources, efficient use of supplies, access to healthcare and doing triage when admitting patients in rural health unit or clinics.

beneficence and nonmaleficence

"to do good and avoid harm"

veracity

"truthful communication"

fidelity

"honoring commitment to duty and standards"

autonomy

"to respect self-determination"

OCCUPATIONAL HEALTH NURSING

It is a specialty nursing practice that provides for and delivers health and safety programs and SERVICES TO WORKERS, worker population, and community groups.

OCCUPATIONAL HEALTH NURSING

A specialty practice that focuses on the promotion, prevention, and restoration of health within the context of a SAFE AND HEALTHY ENVIRONMENT. It includes the prevention of adverse health effects from OCCUPATIONAL and environmental hazards

Rule 1965.04

In the Philippines, _________ of the Amended OSHS published by DOLE (1996) stipulated the expected duties and functions to be performed by occupational health nurses

1. Organizing and administering a health service program integrating occupational safety in the absence of a physician; otherwise, these activities of the nurse shall be in accordance with the physician.

2. Providing nursing care to injured or ill workers.

3. Participating in health maintenance examination. If a physician is not available, performing work activities that are within the scope allowed by the nursing profession, and if more extensive examinations are needed, referring the same to a physician.

4. Participating in the maintenance of occupational health and safety by giving suggestions in the improvement of working environment affecting the health and well-being of the workers.

5. Maintaining a reporting and records system and, if a physician is not available, preparing and submitting an annual medical report, using the prescribed form to the employer as required by this standard.

READ

The expected duties
and functions to be performed by occupational health
nurses

SCHOOL HEALTH NURSING

A specialized practice of public health nursing, PROTECTS AND PROMOTES STUDENT HEALTH, facilitates normal development, and advances academic success.

School nurses

THEY must be prepared to work with CHILDREN of different ages and under highly valuable circumstances.

CORRECTIONAL HEALTH NURSING

Their job is to provide physical and mental healthcare for DETAINEES AND INMATES.

CORRECTIONAL HEALTH NURSING

A specialized SUBSET OF FORENSIC NURSING.

health care system

The ___________ has been evolving from focusing on individuals in acute care settings TO BEING MORE COMMUNITY BASED and population health directed.

Nursing practice

_____________ has changed in response and today a growing proportion of nurses are working outside of hospitals.

population-focused

Public and community health nursing practice includes ____________ interventions that seek to improve health and well-being of groups, aggregates, and communities.

1. focus
2. approach
3. underpinning

As a specialized field of nursing practice, community and public health nursing CAN BE DISTINGUISHED FROM OTHER AREAS of nursing in three major points: (3)

1. DEVELOPMENTAL
2. MULTIDISCIPLINARY
3. ECOLOGY ORIENTED
4. PROMOTES SOCIAL JUSTICE
5. VALUES CONSUMER INVOLVEMENT
6. USES PREPAYMENT MECHANISM
7. FOCUSES ON PREVENTATIVE SERVICE
8. OFFERS COMPREHENSIVE CARE

CHARACTERISTICS AND FEATURES OF COMMUNITY AND PUBLIC HEALTH NURSING (8)

Health education

It is a primary ACTIVITY THAT NURSES INCORPORATE IN ALL PUBLIC HEALTH ACTIVITIES AND INTERVENTIONS as an approach TO HELP PEOPLE ACQUIRE KNOWLEDGE AND SKILLS and ultimately instill health consciousness among them.

community-based

The largest portion of the health care delivery system is _____________ and that care is provided in the natural environment of people.

Health

________ is A HUMAN RIGHT and all people should enjoy access to healthcare.

Social justice

Allocates resources and healthcare budget FOR THE BENEFIT OF ALL AT LEAST FOR THE GREATEST NUMBER.

partners in health

Patients in community/public health are not merely consumers or end-users of healthcare service. They are
considered as _____________.

active participation

Moreover, the need for patients to be responsible for their own health is paramount in this field hence the
____________ of communities is essential in all levels at all stages.

taxes

Services provided by public health system are not given for free. It is funded by _________ of the people.

Healthcare

_____________ is a BASIC SOCIAL SERVICE that should be provided by the state to all people. As for the nurse in the community, he/she is fundamentally committed to attend to patients in communities regardless of their status since all are paying taxes directly or indirectly.

True

True or False

Exception to PREPAYMENT MECHANISM rule applies to out of pocket expense for private home healthcare and hospice services.

1. Pender's Health Promotion Model (HPM)
2. Health Belief Model (HBM)
3. Transtheoretical Model (TTM)
4. Theory of Reasoned Action (TRA)

THEORETICAL MODELS / APPROACHES (4)

Pender's Health Promotion Model (HPM)

This model DEVELOPED IN THE 1980s and REVISED IN 1996.

Pender's Health Promotion Model (HPM)

This model explores the numerous biopsychosocial factors that influence individuals TO PURSUE HEALTH PROMOTION ACTIVITIES.

Pender's Health Promotion Model (HPM)

This model DOES NOT INCLUDE THREAT AS A MOTIVATOR, as threat may not be a motivating factor for clients in all age groups

Health Belief Model (HBM)

This model was INITIALLY PROPOSED IN 1958.

Health Belief Model (HBM)

This model PROVIDES THE BASIS for much of the practice of health education and health promotion today.

Health Belief Model (HBM)

This model was developed by a group of social psychologists to ATTEMPT TO EXPLAIN WHY THE PUBLIC FAILED TO PARTICIPATE IN SCREENING FOR TUBERCULOSIS (Hochbaum,
1958).

Health Belief Model (HBM)

This model documented that INFORMATION ALONE IS RARELY ENOUGH TO MOTIVATE ONE TO ACT. Individuals must know what to do and how to do it before they can take action.

Also, the information must be related in some way to the individual's needs.

Health Belief Model (HBM)

This model has been USED TO EXPLAIN BEHAVIOR CHANGE and maintenance of behavior change and to guide health promotion interventions

Perceived susceptibility

KEY CONCEPTS AND DEFINITION OF THE HEALTH BELIEF MODEL

ONE'S BELIEF regarding the CHANCE OF GETTING A GIVEN CONDITION.

Perceived severity

KEY CONCEPTS AND DEFINITION OF THE HEALTH BELIEF MODEL

ONE'S BELIEF regarding the SERIOUSNESS OF A GIVEN CONDITION.

Perceived benefits

KEY CONCEPTS AND DEFINITION OF THE HEALTH BELIEF MODEL

ONE'S BELIEF in the ability of an advised ACTIONS TO REDUCE THE HEALTH RISK or seriousness of a given condition.

Perceived barriers

KEY CONCEPTS AND DEFINITION OF THE HEALTH BELIEF MODEL

ONE'S BELIEF regarding the TANGIBLE AND PSYCHOLOGICAL COSTS of an advised action.

Cues to action

KEY CONCEPTS AND DEFINITION OF THE HEALTH BELIEF MODEL

STRATEGIES or conditions in one's environment THAT ACTIVATE READINESS TO TAKE ACTION.

Self-efficacy

KEY CONCEPTS AND DEFINITION OF THE HEALTH BELIEF MODEL

ONE'S CONFIDENCE in one's ability to take action TO REDUCE HEALTH RISK.

Transtheoretical Model (TTM)

This model is based on the ASSUMPTION THAT BEHAVIOR CHANGE TAKES PLACE OVER TIME progressing through a sequence of stages.

Transtheoretical Model (TTM)

This model assumes that EACH OF THE STAGES IS BOTH STABLE AND OPEN TO CHANGE. In other words, one may stop in one stage, progress to the next stage, or return to the previous stage.

Precontemplation

TTM STAGES OF CHANGE

The individual has NO INTENTION TO TAKE ACTION toward behavior change in the next 6 months. May be in this phase because of a lack of information about the consequences of the behavior or failure on previous attempts at change.

Contemplation

TTM STAGES OF CHANGE

The individual HAS SOME INTENTION TO TAKE ACTION toward behavior change in the next 6 months. Weighing pros and cons to change.

Preparation

TTM STAGES OF CHANGE

The individual INTENDS TO TAKE ACTION WITHIN THE NEXT MONTH and has taken steps toward behavior change. Has a plan of action.

Action

TTM STAGES OF CHANGE

The individual HAS CHANGED OVERT BEHAVIOR FOR LESS THAN MONTHS. Has changed behavior sufficiently to reduce risk of disease.

Maintenance

TTM STAGES OF CHANGE

The individual HAS CHANGED OVERT BEHAVIOR FOR MORE THAN 6 MONTHS. Strives to prevent relapse. This phase may last months to years.

Pros

DECISIONAL BALANCE

The BENEFITS of behavior change.

Cons

DECISIONAL BALANCE

The COSTS of behavior change.

Theory of Reasoned Action (TRA)

This model was developed by Fishbein and Ajzen

Theory of Reasoned Action (TRA)

This model ATTEMPTS TO PREDICT A PERSON'S INTENTION TO PERFORM OR NOT TO PERFORM a certain behavior

Theory of Reasoned Action (TRA)

This model is based on the assumption that ALL BEHAVIOR IS DETERMINED BY ONE'S BEHAVIORAL INTENTIONS.

These intentions are DETERMINED BY ONE'S ATTITUDE regarding a behavior and the subjective norms associated with the behavior

Theory of Reasoned Action (TRA)

In this model, ONE'S ATTITUDE IS DETERMINED BY ONE'S BELIEFS about the outcomes of performing the behavior, weighed by one's assessment of the outcomes.

Perceived control

A variable of TRA

This accounts for the AMOUNT OF CONTROL an individual may have over whether or not he or she performs the behavior.

Theory of Planned Behavior

With the addition of perceived
control, the ____________ was developed